Mortality in abdominal aortic aneurysm surgery--the effect of hospital volume, patient mix and surgeon's case load.

Abstract

Assessment of mortality in abdominal aortic aneurysm surgery. A 4-year cross sectional study based on a nationwide vascular registry: Finnvasc. A total of 17,465 vascular interventions included 929 elective repairs for abdominal aortic aneurysms (AAA), and 610 emergency cases with 454 ruptures. Fifty-three percent of the operations were done in university hospitals, 44% in central hospitals and 3% in district hospitals. The 30-day mortality rate for AAA repair was 5.1% in elective and 46% in ruptured cases. A clear dependence of operative mortality on surgeon's experience in AAA surgery was observed, both regarding the surgeon's total vascular case load (p < 0.01) and the number of operated elective aneurysms (p < 0.01), but not the number of operated ruptured aneurysms. However, no association was found between hospital volume and mortality in AAA surgery. Vascular surgical experience clearly improves the results of elective aneurysm surgery.